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Morphine Sulphate

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Version Jan 2023

Give dose slowly according to effect. Always be prepared to manage respiratory depression with Naloxone and resuscitation equipment. Some people are over sensitive

About : Always check the BNF link here

Opiate. See BNF or equivalent for UpToDate prescribing advice

Mode of action

Strong opiate acts on opioid receptors

Indications /Dose

Consider starting at 2.5 mg if frail and elderly
Acute Severe Pain: Morphine 5-10 mg SC/IM 4 hourly (give one third to half dose if IV route)
Acute MI: Morphine 2.5-5 mg slow IV stat over watch for respiratory depression
Acute LVF: Morphine 2.5-5 mg slow IV stat over 5 mins watch for respiratory depression
Chronic pain: Morphine 20-30 mg PO daily is safe for opioid-naive patients and 40-60 mg daily for patients being switched from a regular weak opioid.
Give as slow-release MST (Continus) 10 mg BD and slowly increase.
Palliation: Morphine 10-20 mg in Syringe driver over 24 hrs increased as needed
Usually combined with anti-emetic

Dose Range: Morphine doses can increase over time if indicated

Name	Dose	Frequency	Route
Morphine Sulphate (Short acting e.g. Oramorph 10 mg/5ml)	5-10 mg	Every 4 hours PRN	PO (Max dose 120 mg/day . For breakthrough pain. Increase BD dose.)
Morphine Sulphate (Long acting e.g. Modified release)	10 mg	12-hourly.	PO. Up titrate as needed
Morphine Sulphate	2.5-5 mg	4-hourly PRN for pain, LVF, operative	IV/SC/IM
Morphine Sulphate	10-20 mg/24 hrs	Syringe pump SC Often for palliation	IV/SC/IM

Interactions

Avoid with MAOIs now or recent usage. See BNF for a full list.
Avoid with other sedating drugs

Cautions

Can worsen hypotension and respiratory depression
Reduce dose in liver, renal failure, heart failure or elderly

Contraindications

Respiratory depression, Severe COPD, Muscle weakness, Myasthenia
Bowel obstruction or ileus.

Side effects

Nausea, vomiting, Constipation, Ileus, Itch, hypotension, sedation
Dry mouth, urinary retention, reduced cough reflex, anorexia
Delirium, restlessness, seizures, miosis, bronchospasm
Biliary tract spasm, low libido, rhabdomyolysis

References

Morphine in BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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